One-shot balloon dilation of esophageal stricture due to unusual lichen planus localization.

A 77-year-old female was admitted to our hospital for worsening of dysphagia and weight loss. Past clinical history was remarkable for type 1 diabetes mellitus and hypothyroidism secondary to previous Hashimoto‘s thyroiditis. Physical examination showed no systemic signs of Lichen Planus (LP). Upper endoscopic examination revealed the presence of a tight proximal esophageal stricture (Fig. 1) with mucosal alterations (i.e. erythema and web-like areas) not crossable even with the use of a small caliber (pediatric) endoscope. Esophageal biopsies were obtained for histology. They revealed a lymphohistiocytic inflammatory infiltrate involving the superficial lamina propria and basal epithelium with basal keratinocyte degeneration, and the presence of Civatte’s bodies (Fig. 2, H&E x20). Therefore, under deep sedation the patient underwent endoscopic balloon dilation of the proximal esophageal stricture with CRE (Boston Scientific Inc.). The balloon was inflated to 10mm for 30 s and then to 12mm for further 30 s. The stricture was immediately resolved without complications (Fig. 3). After three months, the patient underwent an upper endoscopic control that revealed complete resolution of the stenosis, and only slightly fibrotic tissue was seen at the site of dilation. Lichen planus incidence ranges from 0.5% to 2% in the general population [1]. Esophageal involvement is a rare and under-recognized manifestation of LP and only a few cases have been reported to date [1-3]. The diagnosis is usually made by a combination of history, endoscopic, and histological features. Esophageal LP manifestations usually do not show IMAGE OF THE ISSUE